Impaired Efferocytosis by Synovial Macrophages in Patients With Knee Osteoarthritis

Objective Osteoarthritis (OA) exposes all joint tissues to physiologic stresses, increasing the need to clear apoptotic cells from tissues, including the synovium. We undertook this study to assess the burden of apoptotic cells in synovial tissue in patients with late‐stage knee OA and to investigate whether OA impairs the macrophage‐mediated clearance of apoptotic cells via efferocytosis. Methods Synovial tissue was collected from individuals with healthy knees and patients with late‐stage knee OA during arthroplasty. Synovial apoptotic cell burden was assessed by immunofluorescence for cleaved caspase 3. Efferocytosis of apoptotic Jurkat cells by CD14+ synovial tissue macrophages and peripheral blood–derived macrophages was quantified using immunofluorescence microscopy. Effects of OA on macrophage‐mediated efferocytosis were modeled by stimulating blood‐derived macrophages with synovial fluid collected from individuals with healthy knees and patients with early‐ or late‐stage knee OA. Results Patients with late‐stage knee OA had more apoptotic synovial cells compared to healthy individuals. There was a marked reduction in the fraction of synovial tissue macrophages engaging in efferocytosis and the quantity of material efferocytosed by individual macrophages in OA patients. Blood‐derived macrophages exposed to synovial fluid from patients with knee OA recapitulated the defective efferocytosis, with the greatest effect from patients with early‐stage knee OA and higher disease activity (pain and inflammation). Conclusion Apoptotic cells accumulate in the synovium of patients with late‐stage knee OA. Our results suggest that OA impairs critical homeostatic functions of synovial macrophages, leading to accumulation of apoptotic cells.